Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging. Reports of parent perspectives on navigating language discordance in health care are limited. We analyzed portions of 48 interviews focused on language barriers from 2 qualitative interview studies of the pediatric health care experiences of LEP Latina mothers in 2 urban US cities. We found mothers experienced frustration with health care and reported suboptimal accommodation for language barriers. Six themes emerged relevant to health care across settings: the “battle” of managing language barriers, preference for bilingual providers, negative bias toward interpreted encounters, “getting by” with limited language skills, fear of being a burden, and stigma and discrimination experienced by LEP families. Parents’ insights highlight reasons why effective language accommodation in health care remains challenging. Partnering with families to address the management of language barriers is needed to improve health care quality and safety for LEP patients and families.

Ondansetron therapy decreases the risk of persistent vomiting, the use of intravenous fluid, and hospital admissions in children with vomiting due to gastroenteritis. Future treatment guidelines should incorporate ondansetron therapy for select children with gastroenteritis.

WHAT'S KNOWN ON THIS SUBJECT: Language barriers adversely affect health care access, utilization, outcomes, and patient safety. Trained formal interpreters can improve care quality and safety, but many patients and families with limited English proficiency do not receive appropriate language services during health care encounters.WHAT THIS STUDY ADDS: Despite continued growth of the US population with limited English proficiency, federal language use standards, and enhanced education about appropriate use of language services, there has been only modest improvement over time in pediatricians' use of language services. RESULTS: Most pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P , .01). A higher percentage of pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P , .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P , .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24-4.40).CONCLUSIONS: US pediatricians' use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use. Pediatrics 2013;132:e396-e406 AUTHORS:

Children in immigrant families had significantly lower odds of ACE exposure despite higher prevalence of poverty. This may not reflect a true health advantage in this population. There may be unmeasured factors that buffer children in immigrant families from ACE exposure, or ACE questions may not capture the adverse experiences specific to immigrant families.

Objectives To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. Study design Internet-based survey of a national sample of parents (n=820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariate negative binomial regression to assess associations between enhanced access services and ED use. Results The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Fewer than one-half of parents reported access to their child’s primary care office on weekends (47%), after 5:00 pm on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7-56%, depending on service). Office hours after 5:00 pm on ≥5 nights a week was the only service significantly associated with ED utilization in multivariate analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). Conclusions The majority of parents report enhanced access to their child’s primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce emergency department use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.

The objective of this study is to inform medical home implementation in practices serving limited English proficiency Latino families by exploring limited English proficiency Latina mothers’ experiences with, and expectations for, pediatric primary care. In partnership with a federally-qualified community health center in an urban Latino neighborhood, we conducted semi-structured interviews with 38 low-income Latina mothers. Eligible participants identified a pediatric primary care provider for their child and had at least one child 3 years old or younger, to increase the probability of frequent recent interactions with health care providers. Interview transcripts were coded and analyzed through an iterative and collaborative process to identify participants’ satisfaction with and expectations for pediatric primary care. About half of the mothers interviewed were satisfied with their primary care experiences. Mothers suggested many ways to improve the quality of pediatric primary care for their children to better meet the needs of their families. These included: encouraging providers to invest more in their relationship with families, providing reliable same-day sick care, expanding hours, improving access to language services, and improving care coordination services. Limited English proficiency Latina mothers expect high-quality pediatric primary care consistent with the medical home model. Current efforts to improve primary care quality through application of the medical home model are thus relevant to this population, but should focus on the parent-provider relationship and timely access to care. Promoting this model among practices that serve limited English proficiency Latino families could improve engagement and satisfaction with primary care.

Latino children in the United States, whether immigrants themselves or children in immigrant families, are at high risk for mental health disorders stemming from poverty, exposure to trauma, assimilation stressors, and discrimination. The timely identification and treatment of mental health disorders in Latino children are compromised by limited healthcare access and quality as well as the lack of routine mental health screening in pediatric primary care. Here we review Spanish-language validity and implementation studies of Bright Futures previsit mental health screening tools and models of care. We identify strengths and weaknesses in the literature and suggest tools for use in mental health care assessment, management, and treatment for Latino children in pediatric primary care. Pediatricians can improve care of Latino children through awareness of risk factors for mental health disorders, integration of evidence-based screening tools, and advocacy for culturally tailored mental health resources.

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